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Psychiatric Advance Directives: Taking Charge of Your Care

An advance directive is a written document that expresses your wishes in advance about what types of treatments, services and other assistance you want during a personal mental health crisis. A directive provides a clear statement of your medical treatment preferences and other wishes or instructions. You can also use it to grant legal decision-making authority to another person to be your advocate and agent until the crisis is over.

What are the benefits of having an advance directive?

A psychiatric advance directive can:

Promote your autonomy and empowerment;

Enhance communications between you, your doctor, treatment team and family;

Protect you from ineffective, unwanted or possibly harmful treatment or actions;

Help prevent crisis situations and reduce the use of involuntary treatment or safety interventions, such as restraint or seclusion.

When will I need an advance directive?

An advance directive goes into effect if you are hospitalized and it has been determined that you lack the capacity to make decisions for yourself. By writing your advance directive when your capacity is not in question, you have the opportunity to better influence what happens during a hospital stay. In an emergency situation, however, it is important to understand that doctors retain the authority to make decisions that are deemed necessary to ensure your safety and that of other patients and hospital staff.

What should a psychiatric advance directive include?

You can include the medications and dosages that you know are most helpful to you and those that you do not wish to receive; names of facilities or healthcare professionals you want involved in your care, and people who can help you with important activities (such as paying your bills, and taking care of your children, pets or plants). You can also even identify the people you do or do not want as visitors if you're hospitalized.

One of the more powerful features of an advance directive is your ability to designate someone else (an agent) to make decisions for you if you are admitted to a hospital. You can name that person by stating that only he or she should make decisions for you in the event that you have been determined to lack the capacity to do so.

Duke University maintains a national resource center on psychiatric advance directives that provides background information and a guide to laws in each state.

Who should be my agent?

The person you select should be someone you trust to advocate for you - a family member or friend. He or she will tell others what kind of treatment you do or do not want, and supervise your care. You may wish to choose more than one agent. You can make one the primary agent and designate another as a back up, or you could give each person different responsibilities. Perhaps you trust one person to make your healthcare decisions and another to take care of your household matters (bills, etc.). Be clear about who should do what.

Before naming an agent, discuss your plans with the person(s) you want to designate. Each of them must fully understand your request.

Do I need a lawyer to prepare an advance directive?

State laws vary. To maximize the enforceability of your advance directive, you may wish to consult with an attorney or someone from your state's protection and advocacy (P&A) program to see what your state allows. To find the P&A system in your state, visit the National Association of Protection and Advocacy Systems' Website at www.napas.org, or call (202) 408-9514.

Who should have a copy of my advance directive?

It's important that people know you have an advance directive and know where to find it. Put a copy in your home where it can be easily found; and, put another one in a safe place with your other important papers. Be sure to give copies to people you trust - your agent or a trusted friend or relative; you should also have one on file at any hospital where you have been a patient before.

Can I change my mind?

You can change the contents of your advance directive by making corrections or writing out a new one. However, it is your responsibility to ensure that everyone has a copy of your most current advance directive.

Depending on where you live, you can also choose to make your advance directive revocable. This means you can reserve the right to cancel your advance directive even during a crisis. This must be stated in writing. However, if you choose to revoke your advance directive, your agent will no longer be able to advocate for you. Before you decide whether to make your advance directive revocable, you should thoroughly discuss this with your friends, family and healthcare providers.

Where can I find more information?

Mental Health America's My Plan, My Life program provides information and educational videos about Psychiatric Advance Directives for consumers, providers and family members.